Aging Voice Problems

Aging Voice Problems

Presbyphonia, Presbylaryngeus

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Voice problems -- such as voice weakness or tremor -- that develop with age can affect you socially and emotionally, possibly even leading to isolation and depression. Duke voice specialists use the latest techniques and bring years of experience to evaluating your voice problem and helping make your voice stronger so you can stay engaged in all the things you love to do.

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Voice Problems as We Age

As we get older, our voices change. Some of this stems from other aging-related processes: We lose muscle mass, our mucous membranes thin and become drier, our lung capacity lessens, and we lose some of our fine muscle coordination. Changes can also occur in the voice box, such as vocal cord atrophy or bowing (presbyphonia or presbylaryngeus).

Changes in the voice as we age can include:

  • Higher pitch in men
  • Lower pitch in women
  • Reduced volume or projection of the voice
  • Reduced vocal stamina
  • Tremor or shakiness of the voice

voice evaluation can clarify your diagnosis and determine the best treatment for your condition. 


Comprehensive Evaluation

Assesses your voice use patterns -- how much you speak, sing, or use a loud voice, and what your voice sounds like. Your laryngologist will evaluate the role of any medical conditions that can cause voice changes, such as surgeries or recent illness. We will perform a head and neck examination and a visual examination of your voice box.


This detailed visual exam helps us evaluate how your vocal cords vibrate while you speak or sing. A tiny camera attached to a small tube called an endoscope is inserted through your nose and allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow motion video images of your vocal cords. The exam takes only about a minute, and your nose may be sprayed with topical anesthetic for your comfort. 

The exam allows your team to look for lesions, stiffness, paralysis, irregular movements, throat strain, incomplete closure of the vocal cords, or other physical contributors to your voice problem. After the exam, your team will review the images with you to determine an accurate diagnosis and treatment plan. Laryngovideostroboscopy can be essential to reaching an accurate diagnosis and determining the best treatment for your voice.

Computerized Acoustic Analysis

If voice therapy is recommended, this non-invasive exam is completed at your second clinic visit. It creates a visual display on a computer screen as you speak into a microphone. You and your speech pathologist can see characteristics of your voice, including pitch, loudness, and vocal quality. This test is used to identify abnormalities, including subtle vocal problems that cannot be detected with the unaided ear. It may be repeated during treatment to monitor your progress.

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If your voice feels weak and you can't be heard, there are many options available to strengthen your voice.

Voice Therapy

Voice therapy helps you learn to relax your throat muscles, use your breath to power your voice, and use good oral resonance. You'll work with a speech pathologist who guides you through vocal exercises to improve breathing, reduce throat strain, and find your optimal pitch and volume for strong, healthy speaking.

Temporary Vocal Cord Augmentation

Injectable fillers add bulk to vocal cords that have lost muscle tone due to aging or vocal cord paralysis. The material is injected using a tiny needle inserted into one or both vocal cords. The injection helps the vocal cords close better, creating a stronger voice. This can be done in the operating room or during an office visit. The fillers are reabsorbed by your body over time.

Permanent Vocal Cord Augmentation

Helps the vocal cords close better and improves your voice. A small amount of fat is removed from your belly and injected via a tiny needle to permanently plump specific areas of the vocal cords. This procedure is performed under general anesthesia. A repeat injection is sometimes needed, since some fat is reabsorbed by the body.


An implant (like a tiny shim) is placed through the voice box to reposition your vocal cord and produce a stronger voice. This procedure requires a small incision in the neck.

Duke University Hospital is nationally ranked in 10 adult specialties
Consistently Ranked Among the Nation’s Best Hospitals
In addition, Duke University Hospital is proud to be named the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2019–2020.

Why Choose Duke?

Comprehensive Care
We are one of the few centers in the Southeast offering comprehensive care for voice problems in older adults. We coordinate your care with other specialists to manage any medical conditions that affect your voice.

A Team of Specialists
Your care team will include laryngologists -- ear, nose and throat doctors with advanced training in voice problems -- and speech-language pathologists who specialize in treating voice problems in older adults.

Expert Diagnosis
You'll benefit from a comprehensive voice evaluation that looks into all the factors that may be causing your voice problem. These include medical conditions, medications, and the way you use your voice, as well as your age. 

The Latest Treatments
Our laryngologists are trained in the most advanced techniques in voice surgery, whether it's vocal cord augmentation (plumping the vocal cords for a better sound) or microsurgery to remove vocal cord lesions.

Special Services for Singers and Voice Performers
If you sing, professionally or for personal enjoyment, you can consult with our clinical singing voice specialists -- speech pathologists who are also experienced performers, singers, and singing teachers. They are trained to work with the whole age range of voices and are skilled in treating the special problems with the singing voice as we age.

Reviewed: 02/19/2018